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Archive for category: Original Posts

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Snow Removal O-Tip of the Week: Don’t Wait for the Storm to Subside

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

Snow shoveling can be very strenuous work, especially when dealing with large amounts.  Therefore, as long as it is safe to be outside, it is suggested that you try to tackle the snow in stages.  This may mean going out and shoveling multiple times throughout a snowfall.  Waiting until all the snow has fallen will make the snow harder to move, which can increase the chance of injury.  Set yourself a timer and go out every 2 hours or so and reward yourself with a cup of hot cocoa each when you finish!

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Breaking the Stigma: Sexuality and Disability

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written by Lauren Halliwushka, Occupational Therapist

Unfortunately, in the ongoing quest for an inclusive and equal-opportunity society, “sex” still sells. What used to be in printed material (magazines, newspapers, and fliers) has turned into an online buffet of images that are posted by people of themselves (often filtered, patched and “enhanced”), by people of others (with and without consent), and by photographers, companies and others whose job is to capture the attention of, and entice millions of people, to buy a product, service or idea. The goal of these “sexy” images is to tap into our intrinsic human need and desire for sexuality by adhering to the societal expectations of what is attractive. 

It has only been in the last few years that the concept of “attractive” is changing. Models are increasingly featured in many different shapes, sizes, ethnicities and some campaigns (thank you Dove) are about “natural” beauty.  But despite this small move in the direction of selling with images of “various types of people” presented as “real”, there is one more similarity in advertising that we often overlook. The models are able-bodied, or to use a totally arbitrary term, they would be considered “normal”. 

Why then do we rarely see individuals with disabilities featured in sexually enticing advertisements? It goes back to society’s assumptions of what beautiful and sexy is. Disabled people, through their history of being marginalized, institutionalized, segregated, or otherwise pitied have not been routinely associated with ‘attractive” as a concept. We need to work together to continue to change this perception and to remove the stigma.

Individuals with disabilities are sexual beings. Like you and me, they also have urges, desires, needs, and fantasies. However, a subset of the general population doesn’t think so. According to a systematic review of qualitative articles, a prominent misconception among a sample of the general public is that individuals with disabilities are asexual. Biologically this is odd because individuals with disabilities undergo the same maturation processes as everyone including puberty, reproduction and hormonal surges. Yes, approximately 1% of individuals are asexual but this is all people, not just those with disabilities. Another common misconception is that individuals with disabilities are only attracted to other individuals with disabilities. Inter-abled couples do exist, and relationships can form before or after a disabling event. Compared to inter-racial couples, however, inter-abled are not as common. Why? Well, it is thought that individuals with disabilities may be unconsciously internalizing the stigma and perspectives of society, which further negatively impacts their self-esteem, self-efficacy, motivation, and perceived sexual autonomy. This claim is supported by a qualitative study that gained the perspectives of individuals with disabilities on the topic of sexuality. A significant theme that emerged is the innate belief that their sexuality was not equal to or desired by individuals without disabilities. As such, they were reluctant to pursue inter-abled relationships due to fear of rejection, the partner resenting their disability and the possibility of the partner falling into a caregiver role.

In addition, stigma unknowingly creates various systemic barriers that further reinforce societal and self-stigma among individuals with disabilities, creating a negative counter-productive cycle. There is plenty of literature that highlights the ineffectiveness or inaccessibility of sexual education within secondary schools for individuals with both visible and invisible disabilities. Sexual education focuses on “normal” (that ugly word again) people. Hence, from a young age, we are setting up individuals with disabilities for failure by reinforcing self-stigma and neglecting to acknowledge their sexual being.

Regarding the healthcare system, a study suggests that only 6% of licensed health care professionals engage in frequent discussions about sexuality with patients/clients with half of them stating they avoid the topic due to embarrassment. Keep in mind, this statistic is regarding all individuals, disability or not, which is even more surprising given that sexuality is a crucial component of someone’s health and – more importantly – intrinsic to human nature. No wonder individuals with disabilities are adopting self-stigma if health care professionals shy away from this topic.

This is not about changing what you see as attractive. This is about challenging the opinion that individuals with disabilities are not capable of being sexy and can’t (or shouldn’t or don’t) engage in sexual behaviors. Not only are all people, disabled or not, able to engage in any and all sexual behaviors, but they also have wants, needs and desires like the rest of us. Healthcare professionals that shy away from, or avoid, this topic should consider discussing this aspect of health with patients/clients when appropriate by adopting a comfortable strategy (such as the ex-PLISSIT model).

If you have personally felt, or still feel, the self-stigma surrounding sexuality, please discuss it with a trusted family member, friend or healthcare professional. Specifically, Occupational Therapists are trained to be open about this concept and to problem solve the barriers to sexuality and engagement in sexual activity as a very important “occupation (aka life role)” for all of us.

If you are interested in reading more, I recommend The Ultimate Guide to Sex and Disability by Dr. Miriam Kaufman.

Remember: Disability is extremely broad and can impact people in multiple ways. As with all people, consent is always required when engaging in any sexual activity.

 

References:

 

1 Sinclair, J., Unruh, D., Lindstrom, L., & Scanlon, D. (2015). Barriers to Sexuality for Individuals with Intellectual and Developmental Disabilities: A Literature Review. Education and Training in Autism and Developmental Disabilities, 50(1), 3-16. Retrieved June 18, 2018.

2Miller, A. M. (2015, May 4). Asexuality: The Invisible Orientation? Retrieved from https://health.usnews.com/health-news/health-wellness/articles/2015/05/04/asexuality-the-invisible-orientation

3Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

4McDaniels, B., & Fleming, A. (2016). Sexuality Education and Intellectual Disability: Time to Address the Challenge. Sexuality and Disability, 34(2), 215-225. doi:10.1007/s11195-016-9427-y

5Jones, L., Bellis, M., Wood, S., Hughes, K., McCoy, E., Eckley, L., . . . Officer, A. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. The Lancet, 380, 899-907. doi:10.1016/S0140-6736(12)60692-8.

6Dukes, E., & McGuire, B. E. (2009). Enhancing capacity to make sexuality-related decisions in people with an intellectual disability. Journal of Intellectual Disability Research, 53(8), 727-734. doi:10.1111/j.1365-2788.2009.01186.x

7Haboubi, N. ,. J., & Lincoln, N. (2003). Views of health professionals on discussing sexual issues with patients. Disability and rehabilitation, 25(6), 291-296

8 Taylor, B., & Davis, S. (2006). Using the Extended PLISSIT model to address sexual healthcare needs. Nursing Standard, 21(11), 35-40. doi:10.7748/ns2006.11.21.11.35.c6382

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What is Recreation Therapy?

Recreation therapists are certified professionals who work along with a team of health professionals to assist people in achieving optimal quality of life through participation in leisure and recreation.

Therapeutic Recreation Ontario defines Recreation therapy as “a process that utilizes functional intervention, education, and recreation participation to enable persons with physical, cognitive, emotional and/or social limitations to acquire and/or maintain the skills, knowledge, and behaviours that will allow them to enjoy their leisure optimally, function independently with the least amount of assistance and participate as fully as possible in society.”

February is Recreation Therapy Month.  Learn more about this helpful therapy and how it can benefit those struggling with mental illness in the following care of CAMH.

CAMH:  Enhancing life with meaningful activity

 

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Snow Removal O-Tip of the Week: A Lesson on Lifting

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

Clearing snow is a necessity to ensure safety for yourself, visitors and passersby.  Shoveling can be strenuous work, therefore it’s important to use the proper tools and techniques to reduce the risk of injury.

Whenever possible, push the snow rather than lifting. When lifting is needed, follow these tips:

  • Do not try to lift large amounts at one time
  • Hold the shovel close to your body
  • Ensure you keep a slight bend in your knees
  • Lift with your legs while maintaining the natural curve in your back.
  • Always move your feet to ensure your body will face the direction to where you are dumping the snow.
  • Avoid twisting your back
  • Avoid dumping snow over your shoulders
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My Animals Support Me, But Are Not Support Animals

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Every day I benefit from the love of my animals.  In fact, being an animal owner is not only part of my lifestyle, but has absolutely become part of who I am.  My animals provide me with love, comfort, they calm me and make me smile and laugh.  I have one at my feet right now and he is the one that tends to keep an eye on me – never too far away, watching, waiting, and looking for moments to connect with me, steal some cuddles or give me a quick wag to show his support.  My animals also provide comfort and security to my children and it is not uncommon to see a kid doing homework or relaxing in her room while surrounded by her four-legged beasts much like Snow White.  However, like children, animals are not always easy and at times can be all-consuming, frustrating, and difficult to manage.  Pets are not for everyone, especially during times of trauma, transition, or change.  In the end, my dogs provide me and my family with a “service”, but these are far from “service animals”.  I will explain.

Pets are animals that we keep inside to provide us all the comforts and joys that animals can provide.  Sure, we take them outside, but that is equally for their benefit as it is for ours (dog parks, nature walks, doggie play dates).  Maybe to the vet, groomers or to visit with dog-friendly friends.  But pets are typically a hot mess in public spaces.  My dogs are wonderful at home and are trained to be good here, but If I took one of them to a restaurant he would pretend to be looking for some affection while simultaneously snatching the steak off my plate, or diving to grab that roll that landed on the floor.  He would be underfoot and anxious, nervous of the chaos and commotion.  And in getting him into the restaurant he would not hesitate to chase a squirrel across the road while dragging me as the leash holder into traffic with him.  After all he is a pet; he is not trained in how to properly manage public spaces.

True service animals are pets, sure, because they provide all the supports of an animal at home.  But they are also exceptionally well trained to behave in public.  They can navigate public spaces with focus, comfort and ease because they have experience here, and know what is expected.  They are not distracted by squirrels or steak and get used to being so attentive to their owners such that affection from strangers when out of the home is not something they crave.  They are trained to react to situations with consistency and based on what the owner needs – they will not jump on someone in an elevator, bark, urinate in the lobby, or wrap their leash around someone’s leg.  They won’t bite anyone because they are screened as non-aggressive and are trained to have restraint (unless they are a trained guard dog in which case they provide owner protection on appropriate command).  Service animals provide just that – a “service” to someone in need.  They are not just “pets in a vest out in public.”

In Ontario, owners of service animals, in addition to donning the animal in a vest, are required to carry a “prescription” to explain that they need the dog in public spaces.  This “prescription” can be written by a health professional, and to protect the privacy of the animal owner, is often discrete and vague (“requires the service animal for medical reasons or reasons of mental health”).  Many people with these scripts won’t look or act disabled on the surface, hence the need for supporting documentation.  Unfortunately, with service and support dog vests available online, the note becomes necessary to prove a need and to allow the owner of an establishment to be comfortable having the animal inside.

As occupational therapists, we can provide these scripts and notes to owners of service and support animals.  In many settings, we also assist people to obtain funding for the animal and its training.  What we need to understand, however, is the responsibility that comes with this.  Should the animal misbehave at home or in public and harms someone or the owner, the prescriber of the animal could prove liable as the one indicating the animal was needed and was suitable for the purposes of service and support.  To protect ourselves from this, there are things we should consider:

1.      Ensure the animal is not a pet in the first place.  Confirm that the animal is trained, has been vetted to be suitable, and can handle the important responsibilities that come with wearing a service animal vest.  The best way to do this is to ensure the animal was provided by a reputable facility that works with animals for this purpose.  A list of such facilities in Ontario is included below.

2.      Ensure your note has an expiry date.  An open-ended script that could be carried for years or decades does not ensure that you are referring to “this animal” at “this time”.  Consider dating your script to ensure it is reviewed perhaps annually like other processes that involve our signature (parking permits, tax forms, etc.).

3.      Recognize that supporting the funding for someone to obtain or purchase an animal could also be considered a “script” whereby you are taking ownership for this animal as a service dog.  If you complete a letter of recommendation, complete with funding support, that could be enough for someone to carry with them, written by an “occupational therapist” as proof of the need.

4.      In the cases of mental health, consider the value of having this prescribed by a psychologist, psychiatrist or psychotherapist if warranted.  Consider your own knowledge, skills, and experience with the client and their disability in recommending this type of need.  Ensure there is an appropriate diagnosis of mental health which is best obtained from a registered mental health professional.

In researching for this blog, I was provided a very informative and helpful document written by a Psychologist, Registered Dog Breeder, and Executive Director of Hope Heels Service Dogs: Dr. Aanderson.  This resource is also included below.  This document explains service animal laws across Canada, and clearly outlines the differences between a guide dog, service or support dog and pet.  It provides a decision tree to help professionals like myself navigate the important conversation with clients regarding the use of a service dog, and how this differs from a pet, in deciding whether to “prescribe” this or not.

I am sure many of us have witnessed an animal in a public space that was wearing a vest and misbehaving.  In one instance, someone in an elevator with me said to the owner of a vested “support animal” that was climbing on people “there is no way that is a service dog.”  The owner just exited the elevator without responding.  Service animal or not, it is an abuse of process and blatant disregard to the training and time that goes into true service animals to try and present a pet in this way.  Service animals provide an immense amount of support to those they are trained to help.  As professionals, we have a responsibility to continue to safeguard the true use of these animals, the programs that train them and the people that need them.  Consider using Dr. Aanderson’s guide before providing written support for these valuable four-legged aids to daily living.

Resources:

Aanderson Service Dog Prescriber Guidelines

Service Dog Providers in Ontario – Current as of October 2019

 

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Resources for Living with Dementia

Alzheimer’s Disease International estimates that over 135 million people around the world will suffer from dementia by the year 2050, and are concerned about a looming global epidemic. How can you ensure you are doing the best for your brain in the hopes of preventing dementia? The Alzheimer Society of Canada has a fantastic website that outlines the signs and symptoms of dementia, how to care for someone with Alzheimer’s disease, and how to keep your brain fit through regular brain exercise and a healthy diet.

Alzheimer Society Canada: Living with Dementia

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O-Tip of the Week: Visual Notifications

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of January, our O-Tip series will help you to get acquainted with your devices and the awesome accessibility features you may not be aware of.

If you struggle to hear your phone’s notifications or to feel the vibrations there is an additional option — the LED flashing indicator.  This indicator light allows you to see when you have new notifications on your device.  Here is a step by step guide on how to set up the LED flashing indicator for both Apple and Android devices.

For Apple Users:

 

 

 

 

 

 

 

 

 

 

 

For Android Users:

 

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Save a Life — Make Time to Donate

Do you find or make time for television, personal reading, social media, meditation, exercising, or hitting the spa?  Then perhaps you can find time in your schedule to donate blood.

As a health care professional I am reminded daily that blood is a lifesaving resource.  In fact, it is likely that most, if not all, of my clients were a blood recipient at their time of injury.  Yet, according to Canadian Blood Services, there is a problem.  As per their website, less than 4% of Canadians donate blood, while over 60% of people are eligible to do so.  Reasons for non-donation include people having a fear of needles (a legitimate an insurmountable problem for many), but most people simply say they “don’t have the time”.  Yet, Canadian Blood Services has estimated that as early as 2014 they will have a blood crisis as loyal and repeat donors (mostly seniors) will start exceeding donation age and will become recipients making the already large gap between low supply and high demand even larger.  This gap will be worsened by the baby boomers over the next two decades.  It is time the next generation takes on this important responsibility. 

As someone that has never donated (under the category of “no time”), I have since realized that I make time for other things that I consider less important, so it is time for me to become a donor.  I am doing this for several reasons.  One, I have memories of my grandfather, a war veteran, wearing his red blood-drop pin.  I always noticed his pin, worn proud on his lapel, and the thought of becoming a donor reminds me of him.  Two, I have no fear of needles and can make the time because this is important to me.  Three, Canadian Blood Services has made this easy – there is a donation center less than 5Km from my home and I was able to book an appointment online.  Four, as a parent I want to model this behavior for my children.   And five, I recently lost a client who told me that he needed 14 units of blood at the time of his injury and this was a “record”.  His passing has motivated me to finally make the time for this important contribution.

My plan?  Take a book, relax, and take an hour to myself while giving back at the same time.  Based on my blood type after donating I will give myself a big A.   

 

Previously posted June 2013

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Improve Safety in Your Bathroom

Let’s discuss the most dangerous room in the home: the bathroom. For those with limited mobility, or seniors, it is important to consider the fall risks that exist in the bathroom to ensure that people are safely able to go about daily routines. In the video below we will review bathroom hazards and will discuss the many suggestions an Occupational Therapist may make after a home assessment.

We hope you enjoy this video from our Occupational Therapy Video (OT-V) series and can use some of our tips to stay safe at home!

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O-Tip of the Week: Trouble Typing? Try “Talk to Text”

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of January, our O-Tip series will help you to get acquainted with your devices and the awesome accessibility features you may not be aware of.

If typing on a smartphone or tablet is difficult for you, there’s a solution for that.  “Talk to text” converts what you speak into text that you can input, email and or text to others.  Just be sure to warn others about potential spelling mistakes that may occur!  Here is a step by step guide on how to use the talk to text function on both Apple and Android devices.

For Apple Users:

 

 

 

 

 

 

 

 

 

 

 

 

 

For Android Users: